Reimagining Anticoagulation Clinics in the Era of Direct Oral Anticoagulants

摘要: Anticoagulation clinics were initially developed to provide safe and effective care for warfarin-treated patients with atrial fibrillation, venous thromboembolism, mechanical valve replacement. Traditionally, these required ongoing laboratory monitoring warfarin dose adjustment by expert providers. With the introduction of direct oral anticoagulants (dabigatran, rivaroxaban, apixaban, edoxaban), many have questioned need anticoagulation clinic. However, we think that growing number anticoagulant choices creates an urgent expanding traditional role We outline 3 key purposes a reimagined clinic would serve: (1) assist clinicians selecting most appropriate drug from list options (including warfarin), (2) help minimize risk serious bleeding complications careful long-term peri-procedural management, (3) encourage adherence life-saving medications. also describe how repurposing as broader medication safety promote across range cardiovascular conditions high-risk medications (eg, spironolactone, amiodarone). Finally, highlight few existing health systems are overcoming challenges implementing or structure.